Credentialer/medical malpractice insurance collaboration

ABSTRACT

An inventive process is disclosed for linking credentialing information with a medical malpractice insurance application. The credentialing information is automatically transferred from the credentialing questionnaire to an insurance application, and this credentialing information is then used to generate a medical malpractice insurance policy. The medical malpractice insurance policy is a two year policy, in order to coincide with the required re-credentialing of the healthcare provider. The inventive process also includes linking an information database, not created for insurance purposes, with an insurance application.

BACKGROUND OF THE INVENTION

1. Field of Invention

This invention pertains to the art of processes for linking aninformation database with an insurance application, and moreparticularly to the process of linking credentialing information with amedical malpractice insurance application.

2. Description of the Related Art

It is well known that regulatory agencies in the United States requirehealth professionals to have their credentials verified every two years.Verification is a time consuming process that typically includes theassembly of various documents, including proof of the physician'slicense, a valid Drug Enforcement Agency certificate, proof ofcompletion of medical school, proof of board certification, proof ofappropriate work history, etc. Thus, the verification process oftentakes many days and sometimes weeks to complete. Unfortunately, thistime consuming process is the only known way that the regulatoryagencies can ensure the public that it is receiving care from aqualified medical professional.

It is also well known that the National Committee for Quality Assurance(NCQA) sets the standard for credentialing in managed careorganizations. Defined as “the process by which a managed careorganization authorizes, contracts, or employs, practitioners, who arelicensed to practice independently, to provide services to its members,”credentialing simply means making sure that a practitioner is qualifiedto render care to patients.

Although there is likely to be some variation on the specific criteriaused, the basic elements required in establishing proper credentialinginformation for a physician are likely to include the following: a validand current license, clinical privileges in a hospital, valid DrugEnforcement Agency (DEA) or Controlled Dangerous Substance certificate(CDS), appropriate education and training (i.e. graduation from anapproved medical school and completion of an appropriate residency orspecialty program), board certification, appropriate work history,malpractice insurance, and a history of any liability claims. Managedcare organizations also credential nonphysician practitioners, such asdentists, chiropractors, and podiatrists. The primary differencesbetween physician and non-physician practitioners for purposes ofcredentialing, lie in the requirements, and therefore, in theverification of select data. For example, chiropractors are not boardcertified and do not require DEA or CDS certificates.

Credentialing is a necessary and critical step in securing qualifiedpractitioners to render and manage the care of managed care organizationsubscribers or members. The managed care organizations oftentimesdelegate certain activities in the credentialing process. A CredentialsVerification Organization (CVO), which may be certified by NCQA, willverify a practitioner's credentials for a set price. Contracting with aNCQA-certified CVO exempts the hospital, healthcare entity, or managedcare organization from the due diligence oversight requirements,specified by NCQA and the Joint Commission for Accreditation ofHealthcare Organizations (JCAHO), for all the verification services. Bycontracting out the necessary credentialing to a NCQA-certrified CVO,the managed care organizations have met their due diligencerequirements.

CompHealth, a licensed CVO in the United States, has developed a newweb-based credentialing service, moving as much of the process online aspossible. One of the keys to the credentialing service is an Internetapplication called Apply.net. Medical professionals can use theApply.net application to submit their information to CompHealth via theInternet. However, there is currently in the art no known connectionbetween the credentialing services, the credentialing information, andthe insurance industry.

The Federal government has attempted to alleviate some of the problemsof credential sharing among separate government entities. The FederalCredentialing Program was created to attempt to electronically linkcredentialing databases among the federal agencies and departments.However, this credentialing information sharing is limited to thefederal government and does not involve the insurance industry.

The present invention provides a process for quickly and efficientlylinking credentialing information with a medical malpractice insurancepolicy. Difficulties inherent in the related art are therefore overcomein a way that is simple and efficient while providing better and moreadvantageous results.

SUMMARY OF THE INVENTION

In accordance with one aspect of the current invention, thecredentialing information is automatically transferred to an insuranceapplication.

In accordance with another aspect of the present invention, at least onemedical malpractice insurance premium quote can be generated without thephysician having to fill out an application.

Yet another aspect of the current invention includes generating a twoyear medical malpractice insurance policy in order to coincide with therequired re-credentialing of the physician.

In accordance with still another aspect of the current invention, theprocess includes means for generating the information database for anynon-insurance purpose, means for forwarding at least a portion of theinformation from the information database to an insurance participant,means for generating an insurance premium quote, and means fortransferring the at least a portion of the information from theinformation database to an insurance application.

In accordance with another aspect of the current invention, the processincludes a means for providing a questionnaire for gathering informationfor the database, means for inserting a means for obtaining a customer'spermission for release of the information to the insurance participantinto the questionnaire, means for inserting at least one more questioninto the questionnaire, the at least one more question for gatheringfurther information related to a particular insurance product, and meansfor forwarding all of the questionnaires with an affirmative response tothe first question to the insurance participant.

One advantage of the present invention is that the physician will nothave to fill out a separate application form for medical malpracticeinsurance.

Another advantage of the present invention is that the medicalmalpractice insurance policy is of a duration that corresponds to therecredentialing process, thus eliminating the long term need forphysicians to recomplete insurance applications or insurance renewalapplications.

Yet another advantage of the current invention is that the entireprocess can be automated, thereby, creating a quick and efficientprocess.

Still another advantage of the current invention is that the processincreases competition among malpractice insurers by giving them easieraccess to potential insureds.

One more advantage of the current invention is that the process willdrive down the healthcare provider's processing costs, thereby loweringcosts of one of physicians' largest line item expenses, thereby loweringthe costs of healthcare to consumers.

Still other benefits and advantages of the invention will becomeapparent to those skilled in the art to which it pertains upon a readingand understanding of the following detailed specification.

DESCRIPTION OF THE PREFERRED EMBODIMENT

The inventive process is designed to link credentialing information witha medical malpractice insurance application. The credentialinginformation, which the regulatory agencies require of healthprofessionals, can be compiled for each physician by a credentialsverification organization (CVO). The credentialing information, however,can be gathered by any entity licensed to do so. The CVO typicallyobtains and/or verifies required information about each physician,including, a valid and current license, clinical privileges at ahospital, valid DEA or CDS certificates, appropriate education andtraining (i.e., graduation from an approved medical school andcompletion of an appropriate residency or specialty program), boardcertification, appropriate work history, malpractice insurance, and ahistory of liability claims. This information is used by healthcareentities to ensure the public that it is receiving adequate care from aqualified medical professional. What is to be especially noted is thatthe information gathered by the CVO is virtually identical to theinformation required to underwrite a medical malpractice insurancepolicy.

The inventive process begins by having the CVO include means forobtaining the physician's permission for release of the credentialinginformation to the medical malpractice insurance participant. This meansfor obtaining the physician's permission could be in the form of aquestion added to the questionnaire, requesting the physician'spermission. An example of what the question might be is, “May we releasethis information for the purpose of obtaining competitive malpracticeinsurance quotes for you?” The means for obtaining permission could alsoinclude a statement above the signature line stating that by signing thequestionnaire the doctor is giving the CVO permission to release theinformation to the medical malpractice insurance participant. All of thecredentialing questionnaires in which such permission is granted arethen automatically forwarded by the CVO to the medical malpracticeinsurance participant. What is meant by the term “medical malpracticeinsurance participant” is any one, or more, of the following: insurancecompanies, brokers, agents, third party administrators, risk bearers,claims managers, risk managers, insurance marketers, and the like.

Using the credentialing information, at least one insurance premiumquote is generated for the medical malpractice insurance policy. Themedical malpractice insurance participant can provide multiple quotesfrom various insurance companies to the physician. The insuranceparticipant then contacts the physician with the premium quotes andpolicy terms and conditions. By “quote” it is meant either a non-bindingor binding quote of the cost of the insurance policy premium.

If the physician orders the medical malpractice insurance, thecredentialing information is transferred from the credentialingquestionnaire to a medical malpractice insurance application. Anapplication for medical malpractice insurance is then generated by acomputer for the physician.

The insurance participant then delivers the completed application to thephysician for the physician's review and approval.

Once the medical malpractice insurance policy has been approved by thephysician, a two year policy is generated by the insurance participant.This two year policy coincides with the required re-credentialingprocedure for the physician. The physician will no longer be required tofill out a new application for medical malpractice insurance each timethe medical malpractice policy comes up for renewal. Each time there-credentialing is done, which, in the preferred embodiment, occursevery two years, the updated credentialing information can then be sentagain to the insurance participant, and the medical malpracticeinsurance policy can be renewed with expediency and efficiency.

The two year medical malpractice insurance policy is a preferredembodiment of the invention, and is not intended to limit the inventionin any way. The current inventive process also encompasses any length ofpolicy term that coincides with the re-credentialing process. Forexample, if the re-credentialing occurs every three years, instead ofevery two years, a three year medical malpractice insurance policy canbe issued.

Also, the information on the medical malpractice insurance application,since it is almost identical to the credentialing information, can betransferred back to a credentialing questionnaire for any subsequenthealth organizations that require credentialing of the subjectphysician. The medical malpractice insurance participant can transferthis information, and send copies of the credentialing questionnaires tothe various health organizations, thereby saving the physician a greatdeal of time and effort. The physician will no longer be required tofill out multiple credentialing questionnaires for multiple healthorganizations. In the past, a physician had to fill out a credentialingquestionnaire for each and every health organization from which theydesired approval. With the inventive process, the physician need onlyfill out one credentialing questionnaire, and from that, the processtransfers the information to a medical malpractice insuranceapplication. From the insurance application, the credentialinginformation can be transferred to multiple questionnaires to send out tomultiple health organizations. All that the physician needs to do is tocontact the medical malpractice insurance participant and request thatthe insurance participant complete a credentialing application forwhichever health organization the physician wishes. The medicalmalpractice insurance participant can then transfer the information fromthe insurance application to the credentialing questionnaire and providethe completed questionnaire to the physician. The physician then reviewsthe credentialing questionnaire, signs it, and submits it to thecredentialing entity, or health organization. The inventive processencompasses all of the subsequent applications and questionnaires thatthe physician would need for any subsequent health organizations thatrequire the credentialing information.

If a physician has already obtained medical malpractice insurancecoverage, the medical malpractice insurance participant will have all,or most, of the information necessary for the credentialing process.This invention also encompasses the initial step of the process beingthe medical malpractice participant transferring the information fromthe medical malpractice insurance application to the credentialingquestionnaire. In this manner, the credentialing process can beefficiently and quickly completed even after the physician has a medicalmalpractice insurance policy.

In either of the situations where the information is going from theinsurance application to the credentialing questionnaire, or vice versa,it is possible that some of the questions will not match up. If one ofthe questions on either the credentialing questionnaire or the insuranceapplication is left blank due to the questions not matching up, thesequestions will be highlighted, and when the physician receives theapplication or questionnaire, the physician will fill in the highlightedblank spaces.

In the preferred embodiment, the inventive process occurs automaticallyvia electronic transmission and computer data manipulation. The requiredcomputer hardware, and the necessary computer code, would be obvious toone skilled in the computer art.

However, this invention is not limited to the preferred embodiment, andcan be accomplished without the use of computers or electronic means.The methods of transferring information manually, or by way of a hybridcombination of manual and electronic transference, are both encompassedby this invention. In the manual, or hybrid of manual and electronic,transference embodiments, the steps taken to link the insuranceapplication with the credentialing information are identical to thesteps taken in the preferred embodiment, and those steps areincorporated herein by reference.

The present invention is also not limited to the medical malpracticefield, but includes the entire range of insurance participants. Thepresent invention can be used to link any information database, notcreated for insurance purposes, to any type of insurance application.The only information databases not encompassed within this inventionwould be databases created for the purpose of filling out an insuranceapplication, or for the purpose of obtaining any type of insurance. Anexample of the type of information database not encompassed within thisinvention would be an Internet insurance application form. However, anyother information database, not created for insurance purposes, can belinked by this inventive process to an insurance application. The meansby which this information is linked with the insurance application isidentical to the process described in the medical malpractice insuranceprocess, and the steps of the process are incorporated herein byreference. However, when linking the information to other forms ofinsurance, further questions may need to be added in order to gatherfurther, necessary information. An example of some further questions,necessary for life insurance, would be whether someone is a smoker or anonsmoker.

The types of insurance applications that can be linked can include, butare not limited to, the following: life insurance, automobile insurance,medical malpractice insurance, legal malpractice insurance, professionalliability insurance, health insurance, disability insurance, renter'sinsurance, homeowner's insurance, flood insurance, fire insurance,hurricane insurance, and earthquake insurance, or any other line ofinsurance.

It is to be noted that the invention encompasses the idea that thecredentialing organization, the healthcare entity, the insuranceparticipant, etc. can be one entity or separate entities. For example, ahospital that does its own credentialing and provides insurance for itsphysicians is encompassed within this invention.

In another embodiment of this invention, there is no need for acredentialing questionnaire to be provided. The CVO should have all thedata necessary for filling out an insurance application, and all thatwould be needed would be the physician's permission for use of theinformation. In this embodiment, the initial step of the process wouldbe transferring the credentialing information from the CVO directly intoeither an insurance application or an insurance policy.

The invention also encompasses the use of electronic transmission of theinformation to the physician for the physician's approval. The physiciancould then send approval for the insurance policy back to the insuranceparticipant. Under this method of the invention, no signature isrequired by the physician, only the physician's approval of theinsurance policy.

The invention has been described with reference to preferredembodiments. Obviously, modifications and alterations will occur toothers upon a reading and understanding of this specification. It isintended to include all such modifications and alternations in so far asthey come within the scope of the appended claims or the equivalentsthereof.

1. A process of linking credentialing information with a medicalmalpractice insurance application, the process comprising the steps of:providing a questionnaire for use in compiling credentialing informationconcerning an associated physician to create a first credentialingapplication, the questionnaire including means for obtaining thephysician's permission for release of the credentialing information toan associated medical malpractice insurance participant; electronicallyforwarding the information to an associated credentialing entity;verifying the credentialing information; electronically forwarding thequestionnaire from the credentialing entity to the medical malpracticeinsurance participant if the physician gave permission for release ofthe credentialing information; providing the physician with at least oneinsurance premium quote generated by the medical malpractice insuranceparticipant for use in generating a medical malpractice insurance policyfor the physician based at least in part on the credentialinginformation; preparing a medical malpractice insurance application forthe physician; electronically transferring at least a portion of theverified credentialing information from the questionnaire to the medicalmalpractice insurance application; completing the formation of themedical malpractice insurance application; delivering the medicalmalpractice insurance application to the physician for the physician'sreview and approval; generating the medical malpractice insurance policyto coincide with subsequent credentialing applications for thephysician; electronically transferring the credentialing informationfrom the medical malpractice insurance policy to the subsequentcredentialing application; generating a subsequent credentialingapplication; and, sending the subsequent credentialing application to anassociated healthcare organization to which the physician must providethe credentialing information.
 2. A process of linking credentialinginformation with a medical malpractice insurance application, theprocess comprising the steps of: compiling credentialing informationfrom a credentialing questionnaire regarding an associated healthcareprovider; obtaining the healthcare providers permission for release ofthe credentialing information to a medical malpractice insuranceprovider; electronically forwarding at least a portion of thecredentialing information to an associated medical malpractice insuranceparticipant; electronically transferring the at least a portion of thecredentialing information to a medical malpractice insuranceapplication; and, processing the medical malpractice insuranceapplication based on the at least a portion of the credentialinginformation.
 3. The process of claim 2, wherein after forwarding atleast a portion of the credentialing information from the credentialingentity to the medical malpractice insurance participant, the processcomprises the step of: providing the healthcare provider with at leastone insurance premium quote for a medical malpractice insurance policygenerated by the medical malpractice insurance participant.
 4. Theprocess of claim 2, wherein the process further comprises the step of:delivering the medical malpractice insurance application to thehealthcare provider for the healthcare provider's review and approval.5. The process of claim 4, wherein the step of generating an insurancepremium quote for a medical malpractice insurance policy comprises thesteps of: quoting the insurance premium to the healthcare provider; and,selling the medical malpractice insurance policy to the healthcareprovider.
 6. The process of claim 5, wherein the process furthercomprises the step of: generating the medical malpractice insurancepolicy, the policy being a two-year policy, in order to coincide with arequired re-credentialing procedure for the healthcare provider.
 7. Theprocess of claim 6, wherein the step of forwarding the credentialinginformation to a medical malpractice insurance participant comprises thesteps of: inserting means for obtaining the healthcare providerspermission for release of the credentialing information to a medicalmalpractice insurance provider into the questionnaire, and,electronically forwarding all of the credentialing questionnaires withan affirmative response to the medical malpractice insuranceparticipant.
 8. The process of claim 7, wherein the process furthercomprises the steps of: generating a second credentialing application;electronically transferring the credentialing information from themedical malpractice insurance application to the second credentialingapplication; and, sending the second credentialing application toanother health organization to which the physician must provide thecredentialing information.
 9. The process of claim 8, wherein theprocess further comprises the step of: repeating the preceding threesteps of claim
 8. 10-17. (canceled)
 18. An apparatus for linkingcredentialing information with a medical malpractice insuranceapplication, the apparatus comprising: means for compiling credentialinginformation regarding an associated healthcare provider from acredentialing questionnaire; means for electronically forwarding thecredentialing information to an associated medical malpractice insuranceparticipant; means for generating at least one insurance premium quotefor a medical malpractice insurance policy; and, means forelectronically transferring the credentialing information from thecredentialing questionnaire to the medical malpractice insuranceapplication.
 19. The apparatus of claim 18, wherein the apparatusfurther comprises means for generating the medical malpractice insurancepolicy, the policy being of a duration, in order to coincide with arequired re-credentialing procedure for the healthcare provider. 20-24.(canceled)
 25. A process for linking credentialing information with amedical malpractice insurance policy, the process comprising the stepsof: providing means for obtaining an associated healthcare provider'spermission to release the credentialing information to an associatedmedical malpractice insurance participant; receiving permission from thehealthcare provider to release the credentialing information;electronically forwarding at least a portion of the credentialinginformation from an associated credentialing entity to the medicalmalpractice insurance participant; and, providing the healthcareprovider with at least one insurance premium quote for a medicalmalpractice insurance policy generated by the medical malpracticeinsurance participant.
 26. The process of claim 25, wherein the processfurther comprises the steps of: receiving the healthcare provider'sapproval of the at least one insurance premium quote; and, creating amedical malpractice insurance policy.
 27. The process of claim 26,wherein providing the healthcare provider with at least one insurancepremium quote for a medical malpractice insurance policy generated bythe medical malpractice insurance participant comprises the steps of:providing the healthcare provider with at least one insurance premiumquote for a medical malpractice insurance policy generated by themedical malpractice insurance participant; and, electronicallytransferring the credentialing information to a medical malpracticeinsurance application.
 28. The process of claim 2, whereinelectronically forwarding at least a portion of the credentialinginformation from the credentialing entity to the medical malpracticeinsurance participant further comprises the step of: electronicallyforwarding at least a portion of verified credentialing information fromthe credentialing entity to the medical malpractice participant.
 29. Theapparatus of claim 18, wherein the means for electronically forwardingthe credentialing information to a medical malpractice participantfurther comprises: means for electronically forwarding verifiedcredentialing information to a medical malpractice insuranceparticipant.
 30. The process of claim 25, wherein electronicallyforwarding at least a portion of the credentialing information from thecredentialing entity to the medical malpractice insurance participantfurther comprises the step of: electronically forwarding at least aportion of verified credentialing information from the credentialingentity to the medical malpractice insurance participant. 31-34.(canceled)